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Apr 3, 2024

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Hello Everyone, I am finishing up my marking of the assignments for endo and thought I would address some of the outstanding questions you had from the mock RCT procedure. You all did a very good job with this activity and I am glad to hear that it was a valuable learning opportunity, and it gave clarity to many aspects of endodontics. If you have other questions, I can address them quickly before the exam tomorrow, or you can text me (try to reread text and notes however first. 😊 ) Here are some of the questions you still had (I hope this helps): 1) Why just a single tooth isolation for RCT? Exposing just the tooth being treated keeps bacteria from the oral cavity low and more manageable. The goal with RCT is to completely clean, shape and disinfect the canals. After isolation, the small area (tooth, clamp & DD) is swabbed with antiseptic. 2) How do we maintain sterility during the procedure? - Use of medicaments/ solutions like sodium hypochlorite to wipe instruments and irrigate canals to disinfect and maintain asepsis. - Use of multiple sets of cotton pliers so only the sterile ones are used in packages, drawers, bins etc. Often a specific “sterile” set would be stored at chairside, in a disinfectant during the procedure. - Use of individually packaged items like paper points. - Dispensing of other supplies and medicaments before the procedure begins. - Using overgloves - Avoiding any sort of cross contamination - Use of chairside “glass bead sterilizers” (older school) 3) Can you use just one type of file (hedstrom, K-files, etc) during the sequencing (cleaning, shaping, debriding) of the canals? As you are realizing, much that is done in dentistry is “operator preference” based on evidence- based practice. There are different techniques, instruments and equipment that can all be used to achieve the objective of fully and completely cleaning and shaping a canal. A difference in the design of reamers and files means that they are used in a slightly different manner as well. The endodontic file used in a push / pull rasping motion , and the endodontic reamer in a rotating / twisting motion . The Hedstrom files have a more efficient cutting stroke because of their different design. Rotary files are designed different again and used with yet another technique and sequence. Just like a spoon excavator can be used to remove decay, so can a round bur. There might be different instances that a dentist would choose one over the other, or choose to use both. Endodontic instrumentation is similar.

4) When would a master point get taken out? The master point would get tried in the canal and a radiograph taken to ensure the point comes within .5-1mm of the apex of the tooth. Once the dentist is sure of the fit and length, it would be taken out, covered in sealer paste then reinserted. Accessory points will get added (alternating with a spreader) until a solid core is achieved and the canal is completely obturated. 5) How do you heat up the Glick or other “hot” instrument? Any heat source could be used… a lighter, Bunsen burner, etc. As well there are special electric heat sources like the “Touch and Heat”. 6) Is it easier to use gutta percha when it is heated? Is it more likely to fill the canals better? When I see the intricate canal systems present in tooth anatomy, I would imagine that using a warm gutta percha technique would be more effective at filling those tiny canals than trying to access them with a GP point, sealer paste and a spreader. However, both techniques are still utilized. 7) Why put a dental dam clamp on after the dental dam is placed? Certain clamps, because of their size and design require this order of placement to ensure the best seal of the dental dam material around the tooth. 8) What files can we throw away? Again, dentists have a preference here too. The smallest size instruments, #6 - #15 have a greater risk of fracturing in the canal so some say any intracanal instruments size 15 and less are single use. Other dentists have their CDA’s put a scribed line on the shank after each use. Once the instrument is used 3 times, it will then get thrown out. It can vary. 9) What material is used for a permanent filling? After an RCT the tooth is at a greater risk for fracture so dentists will recommend that it be crowned, however the tooth can be restored with amalgam or composite as well. 10) Where in the sterilization room do I get all the supplies? Different offices will organize their supplies differently. Some may store items in a specific RCT bin in the operatory and others may have drawers and shelves in sterilization that house all the items for these procedures.

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